The pill turns 50: Birth control method is the catalyst of change, controversy

Ability to plan pregnancies transforms lives

Fifty years ago this month, the birth control pill came on the scene.

Comment

By Deborah J. Botti

recordonline.com

By Deborah J. Botti

Posted May. 12, 2010 at 2:00 AM
Updated May 13, 2010 at 11:56 AM

By Deborah J. Botti

Posted May. 12, 2010 at 2:00 AM
Updated May 13, 2010 at 11:56 AM

Do you qualify for free birth control program?

Caren Fairweather is the executive director of Maternal-Infant Services Network of Orange, Sullivan & Ulster Counties Inc., an organization whose mission is to ensure that women of childbearing yea...

» Read more

X

Do you qualify for free birth control program?

Caren Fairweather is the executive director of Maternal-Infant Services Network of Orange, Sullivan & Ulster Counties Inc., an organization whose mission is to ensure that women of childbearing years and their families have access to health care, along with educational, social and nutritional services that healthy families need.

MISN offers childbirth classes, educational programs in schools, professional education and health insurance coordination. "We helped 50,000 people in the mid-Hudson enroll in health insurance in the past 10 years," she says.

For many, reproductive health services fall through the cracks, she says, especially in recent years. That's where the Family Benefit Planning Program, which is administered through the state Department of Health, kicks in.

"It's for people who cannot pay for family planning," says Irene Braga, a nurse practitioner since 1983, who is now patient services director at Planned Parenthood of the Mid-Hudson Valley. "They cannot have other insurance and need to bring in proof of identification, residency, income verification and then apply for the program. We help with the forms."

According the 2009 guidelines on the state Health Department's website, a couple can earn $2,429 a month and still qualify for the program. "The visits must be birth-control-related," says Braga.

Screenings for STDs and a Pap smear are covered, along with certain other procedures, when they're being used to determine the proper form of birth control for the patient.

Fairweather routinely refers people to Planned Parenthood and community health clinics. "It's a safety net for people who are uninsured but generate income," she says. "We involve the fathers, too. Women most often don't get pregnant alone."

Fairweather says MISN encourages the use of this program. Even when pregnancies are wanted, spacing to allow time for a woman's body to replenish plays a role in better birth outcomes.

"We can talk until we're blue in the face, but we need the tools and resources in place," she says.

While it can be argued that the pill played a role in the "sexual revolution," experts agree the cultural changes that have evolved are far more complex.

Tiffany M. Card, community affairs manager with Planned Parenthood of the Mid-Hudson Valley, points to a recent study on premarital sex in the U.S. "We know that about 92 percent of women have sexual intercourse before marriage," says Card. "It was the same in 1954 (before the pill) as it is today."

However, what has changed over the decades — according to "Trends in Premarital Sex in the United States, 1954-2003" by Lawrence B. Giner, director of Domestic Research at the Guttmacher Insitute — is that people are waiting longer to get married, so they are sexually active and unmarried for a much longer time than in the past.

"Two generations ago, many women were pregnant for much of their lives," says Dr. A.J. Koehler, an obstetrician/gynecologist with Crystal Run Healthcare. "Having 10-15 kids to help out on the farm was not unusual. ... Women don't want to do that anymore."

"Nowadays, you couldn't afford all those children," says Jean, who asked that her last name not be used in this story. She is the mother of seven children who are in their 40s and 50s.

"I don't think I would have wanted 12 or 13 children," says Linda, who also asked that her first name only be published. "Personally, I thought it was great when they came out with the pill. It didn't exist when I was in high school, so I think we were much more cautious and willing to wait. Now, women have control, choice — and a sense of relief."

According to the Guttmacher Institute, which conducts research, education and policy analysis of sexual and reproductive health, the typical American woman today wants two children, spends about five years pregnant and three decades trying to avoid pregnancy.

"The pill has helped women plan and space pregnancies," says Card. "They have access to higher education and better-paying jobs."

"Before that, women weren't able to determine what they wanted to do — school, a career. Today, they can make that choice, including motherhood — and be ready to accept all the responsibilities that come with it," says Irene Braga, a nurse practitioner and patient services director of Planned Parenthood of the Mid-Hudson Valley.

It was in 1916 that Margaret Sanger, an obstetrical nurse on the Lower East Side of Manhattan and one of 11 children herself (although her mother had 18 pregnancies), established the first birth control clinic. She noted a correlation among poverty, uncontrolled fertility and higher rates of infant and maternal deaths. In 1921, she founded the American Birth Control League, which later became known as the Planned Parenthood Foundation of America.

"After the FDA approved the pill, Planned Parenthood was one of the first to offer it," says Card. "But the pill was available only to married women when it first came out."

"There really were no birth control pills available when I was having my kids," says Jean, whose first few children were born before the pill. "My husband (recently) joked and said abstinence is the way. I reminded him he wasn't interested in abstinence back then."

By the time 57-year-old Stan, who asked to be identified by his first name only, was a young adult, birth control pills had become available to women regardless of marital status.

"It was our assumption back then that the pill was accessible and that girls took the pill ..." he says. "... It was the beginning of treating sex cavalierly."

Back then, too, family conversations about sex were rare. "Anything I learned, I learned from my peers," he says. "And those were pretty slanted views."

Fast-forward to today, and Stan's views have changed significantly. "I have good, solid values and a spiritual dimension that plays into life. I believe that sex should be reserved for marriage," he says.

And that is what he has communicated to his daughter.

"The responsibility comes back to us as parents to discuss the consequences of unprotected sex and to impart our values earlier," says Stan. "However, if abstinence was not to be my daughter's choice, we would certainly discuss what she was doing to protect herself from an unwanted pregnancy."

Birth control pills have also changed in 50 years. "I don't know how scientific (the hormone doses in the pill) was in the '60s," says Koehler. "But over the past 10 years and with the advent of the lower-dose pills, all the studies are indicating a more scientific approach."

For example, back then, a 21-days-on, seven-days-off cycle of taking a pill made sense, Koehler says. "Today, customizing the pill to control a woman's cycle is right around the corner," he says. "A woman will be able to choose to have a period when she wants."

Koehler says because the pill suppresses the formation of the uterine lining, a monthly shedding of the lining is not required to maintain reproductive health.

But what if a woman was to conceive while taking the pill?

"We used to worry about the pill causing birth defects if a woman conceived too quickly after coming off the pill," Koehler says. "(Now) You can be on the pill, stop, and safely conceive the next month."

"I have no reservations about using the pill for an adolescent with painful, irregular periods or endometriosis," Koehler says. "It's also the first line of defense for acne. The patient might not even be sexually active, but is a good candidate for the pill (to treat these conditions)."

And the pill isn't just for those in their early reproductive years anymore. Again, because of the lower dose of hormones, the pill is now being used later in life.

But women need to be reminded that the average age of natural menopause is 51, and a woman must miss between six and 12 consecutive periods before this transition is considered complete, he says. Prior to that, pregnancy is still a viable possibility.

"There are conflicting studies about the pill's link to increased breast cancer," says Koehler. "You have to weigh the big picture. The pill is also linked to a decrease in endometrial cancer, a decrease in ovarian cancer and a decrease in anemia."

And all the experts underscore that the pill does not prevent against sexually transmitted diseases. "Twenty-five percent of teenage girls may have an STD, and we're aware that most STDs occur in the under-25 population," says Koehler, whose group inherently screens young women.

"We urge people to use condoms," he says. "But we're up against 'the heat of the moment,' a desire to please a partner ... That's real life."

"If you don't want to get pregnant, you shouldn't be having sex. The only 100 percent effective way to avoid pregnancy is abstinence," says Card. "But if you are sexually active, you need to take these precautions — against pregnancy and sexually transmitted diseases."